The goal of the Division of Nephrology Training Program at the University of Washington (UW) is to provide MD and PhD postdoctoral trainees high quality basic or clinical science training in kidney disease and related disorders, so that they may ultimately become independent academic researchers. The rationale is that nephrology was only one of two internal medicine subspecialties which has not increased the number of fellows over the past decade, and has attracted progressively fewer US medical graduates. To meet this urgent need, support for excellence in the training of physician-scientists and basic scientists is critical for future success. Several major changes to our trainig program were instituted during the current grant cycle (July 2009 to present), all of which now have substantial momentum entering this revised competitive renewal (year 30). First, we established the Kidney Research Institute, which provides unique infrastructure and resources to support clinical and translational research including biorepositories, patient registries and over 30 funded clinical trials. Second, the University has committed new state of the art basic science laboratory space to kidney disease investigators, with multiple core facilities available. Third, we have hired 9 NIH funded physician-scientists from outside UW (in addition to the recruitment of 5 physician scientists from 2004-2008). Fourth, we have increased the number of ACGME nephrology fellowship positions from 7 to 10 annually (6 supported by non-training grant funds). Fifth, we have achieved an 8 fold increase in NIH funding in Nephrology during the current grant cycle ($8.3M this past year alone). Substantial accomplishments in the past year alone include one K23 award, one KO8 submitted, one minority supplement grant awarded, 10 published first authored manuscripts by fellows, with an additional 13 manuscripts in advanced preparation. The proposed training includes requesting four postdoctoral fellowship positions annually for trainees to enter one of the following research areas: (1) metabolic disorders and biomarkers; (2) glomerular and tubulointerstitial disorders; (3) kidney related clinical epidemiology and health services research; (4) end stage kidney disease and complications. The training program design requires MDs to first complete a clinical year; PhDs must have completed their accredited training. MDs in the clinical-translational training program are required to enter the Masters or Certificate Program in epidemiology or public health at the UW School of Public Health. Three years of basic and clinical science training is the typical length o the program, during which time all trainees are expected to submit a fellowship grant. A formal mentoring program assists trainees with career and scientific guidance, and a well-designed core curriculum provides all trainees with essential skills in grant writing and other assets required for long-term success. Finally, three committees (Advisory, Admissions and Diversity Enhancement, Curriculum and Coursework) assist the PI, Co-PI and TPD in programmatic governance, and to ensure the programmatic benchmarks and expectations are achieved.